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Ask The Expert: When Dad Won’t Shower

by ROMINA OLIVERIO
Contributor

Romina Oliverio, Alzlive.com’s Ask The Expert columnist, advises one caregiver whose father will no longer bathe.

Question: My dad, who has had Alzheimer’s for about five, six years, now absolutely refuses to shower. I don’t know what’s going on… is it the feeling of water on his face? I’ve tried adjusting the temperature and making the room warm, making him feel as safe as possible. But he just won’t and it’s getting bad.

Answer: For every behaviour exhibited by someone living with Alzheimer’s or other type of dementia, there is an underlying reason. For most of us, there is nothing more relaxing than a warm shower after a long day. However, the sensation of water characterized as soothing by our brains can be interpreted as anything but for people living with Alzheimer’s.

Expressing a fear or discomfort of water is common beginning in the middle stages of Alzheimer’s. As the disease progresses, personal hygiene often falls by the wayside.

Furthermore, depression can cause apathy and result in a loss of interest in personal hygiene. If your dad also exhibits other symptoms of depression (for example, anxiety, agitation, social withdrawal, isolation, loss of appetite, disruption in sleep, loss of drive, etc.) please speak to your doctor immediately.

I applaud you for trying different strategies and ensuring your dad is as comfortable as possible. The topic of personal hygiene can be a trying one for caregivers. Below are tips that may help you, and others, with this sensitive task:

Modesty is a significant issue in personal hygiene. Your dad may feel embarrassed and helpless especially in front of his daughter. When he’s in the tub, drape a towel over his lap or around his shoulders to protect his privacy. Uncover only one area at a time when bathing him. If he’s game, try a coloured bubble bath which will help cover his private areas. Have a warm towel and clothes laid out in sequence so when he’s ready to get out of the tub, he doesn’t have to wait unclothed.

If your dad refuses to undress, invite him to keep his underwear on. He can also wear a bathing suit. The more at ease he feels, the simpler your task will be.

A loss of independence can be crippling. If your dad is able and willing to, encourage him to wash himself by handing him the sponge. You may have to rely on cues such as showing or telling him what to do.

Water cascading from a shower head can be disorienting and frightening. Instead of a shower, try a bath. Try a hand-held shower head. If your dad shows an aversion to having his hair washed, use a dry shampoo.

Those with Alzheimer’s perceive temperature and sensation of water differently. Let your dad feel the water before going into the tub by gently pouring some over his hand. Gauge his reaction to see if the temperature is comfortable for him. You can also use prompts such as reaching into the water yourself and saying, “Doesn’t the water feel nice?” to invite him to follow your lead.

Alzheimer’s affects depth perception. Use neutral coloured bath mats or decals to give your dad a feeling of secure footing. Avoid dark mats as these may be perceived as “holes” or “openings” on the bottom of the tub.

If your dad wears glasses or hearing aids, leave them on during bath time (ensuring they don’t get wet). Being able to see and hear properly will help him feel more comfortable and reduce anxiety.

You may also consider playing his favourite music in the background to relax him.

Finally, once you break this bathing bottleneck, try to stick as closely as possible to past routines. If your dad used to shower in the morning, follow that schedule. Or suggest bathing when you see that he’s at his most relaxed.

Once you’ve got him back on track, keep in mind that a full bath is not necessary on a daily basis. Relying on a sponge or cloth for a partial bath every other day is sufficient.

It sounds like you’ve done your absolute best to make sure the room is adequate. As with any caregiving responsibility, the key ingredients are compassion and empathy. Your thoughtful approach shows you have both. You’re on the right path. Keep trying with some of these tips. Good luck and all my best to you and your family.

An advocate for person-centred care, Romina is U-FIRST certified and has studied Montessori Methods for Dementia; Behavioral Support Training; and Palliative…

An advocate for person-centred care, Romina is U-FIRST certified and has studied Montessori Methods for Dementia; Behavioral Support Training; and Palliative Care for Dementia. Follow Romina on Twitter: @RominaOliverio